{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T22:57:08Z","timestamp":1793746628035,"version":"4.6.1"},"reference-count":32,"publisher":"Georg Thieme Verlag KG","issue":"14","funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"crossref","award":["CTP 87518"],"award-info":[{"award-number":["CTP 87518"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:p>Neonatal vascular air embolism is a rare but often fatal condition. The literature comprises mostly case reports and a few dated systematic reviews. Our objective was to review all case reports of neonatal vascular air embolism to date and provide up-to-date information about patient characteristics, clinical presentations, outcomes, pathogenesis, diagnosis, prevention, treatment, and prognosis. We searched the literature for case reports of neonatal vascular air embolism, using MEDLINE, CINAHL, and EMBASE, and the keywords \u201cneonates\u201d and \u201cvascular air embolism.\u201d Results were summarized. There were 117 cases of neonatal vascular air embolism, with a mean gestational age of 30.4 weeks (range: 23\u201340), mean birth weight of 1,422\u2009g (range 830\u20133,844), and median age of occurrence of 2 days (range: 1\u2013540) after birth. The majority were preterm (75.2%), male (62.7%), on assisted respiratory support (90.5%), and had air leak syndrome (52.9%). The most common clinical presentation was sudden acute clinical deterioration, sometimes accompanied by crying, cardiac rhythm abnormalities, skin discoloration, and a decrease in end-tidal carbon dioxide concentration. Incidence of mortality and adverse neurological sequelae among survivors was 73.9 and 16.6%, respectively, overall, but significantly (p\u2009&lt;\u20090.05) higher among preterm infants (81.8 and 31.2%, respectively) and lower among surgical infants (23.8 and 0%, respectively). Diagnosis included visualizing air in infusion lines or retinal vessels, a decrease in the end-tidal carbon dioxide levels, and radiographic, doppler ultrasound, transesophageal echocardiography, or computed tomography (CT) imaging. The prognosis for neonatal air embolism is poor, especially for preterm infants requiring mechanical ventilation. Prevention is key and treatment is supportive.<\/jats:p>","DOI":"10.1055\/a-2508-2733","type":"journal-article","created":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T19:50:47Z","timestamp":1735329047000},"page":"1819-1824","source":"Crossref","is-referenced-by-count":5,"title":["Vascular Air Embolism in Neonates: A Literature Review"],"prefix":"10.1055","volume":"42","author":[{"given":"Qi","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoo K.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,1,21]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1136\/adc.64.4_Spec_No.507","article-title":"Pulmonary vascular air embolism in the newborn","volume":"64","author":"S K Lee","year":"1989","journal-title":"Arch Dis Child"},{"issue":"12","key":"ref2","first-page":"922","article-title":"Intracardiac air\u2013the \u2018hospital killer\u2019 identified? Case reports and review of the literature","volume":"93","author":"J Smith","year":"2003","journal-title":"S Afr Med J"},{"issue":"12","key":"ref4","first-page":"1392","article-title":"A case of pulmonary vascular air embolism in a very-low-birth-weight infant with massive hydrops","volume":"52","author":"M J Kim","year":"2009","journal-title":"Clin Exp Pediatr"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/0002-8703(49)90001-0","article-title":"Arterial air embolism","volume":"38","author":"T M Durant","year":"1949","journal-title":"Am Heart J"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1046\/j.1460-9592.2002.00873.x","article-title":"Venous air embolus during arthrography in a child: vital signs changes illustrated by the automated data recording system","volume":"12","author":"I Keidan","year":"2002","journal-title":"Paediatr Anaesth"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.1111\/1556-4029.14781","article-title":"Fatal systemic (paradoxical) air embolism diagnosed by postmortem funduscopy","volume":"66","author":"L M Bradley","year":"2021","journal-title":"J Forensic Sci"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1148\/113.1.155","article-title":"Postmortem gas accumulation in premature infants","volume":"113","author":"R G Quisling","year":"1974","journal-title":"Radiology"},{"issue":"20","key":"ref9","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1056\/NEJM197005142822007","article-title":"Gas embolism in hyaline-membrane disease","volume":"282","author":"G A Gregory","year":"1970","journal-title":"N Engl J Med"},{"issue":"S 01","key":"ref10","doi-asserted-by":"crossref","first-page":"S220","DOI":"10.1007\/BF03545636","article-title":"Lymphatic air embolism: a new hypothesis regarding the pathogenesis of neonatal systemic air embolism","volume":"25","author":"T N Booth","year":"1995","journal-title":"Pediatr Radiol"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1055\/s-0029-1214236","article-title":"Air embolism in the newborn: rare complication of intensive care therapy in children","volume":"26","author":"G Beluffi","year":"2009","journal-title":"Am J Perinatol"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1111\/j.1651-2227.1996.tb14042.x","article-title":"Peripheral intravenous infusion\u2013another cause of air embolism","volume":"85","author":"I Levy","year":"1996","journal-title":"Acta Paediatr"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/S0022-3476(78)80311-4","article-title":"High incidence of lung perforation by chest tube in neonatal pneumothorax","volume":"92","author":"A C Moessinger","year":"1978","journal-title":"J Pediatr"},{"issue":"04","key":"ref14","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1001\/jama.1969.03150170082024","article-title":"Neonatal death due to embolism","volume":"207","author":"J R Allen","year":"1969","journal-title":"JAMA"},{"issue":"01","key":"ref15","first-page":"11","article-title":"Fatal systemic air embolism in a neonate after cardiopulmonary resuscitation","volume":"6","author":"A Q Qazi","year":"2015","journal-title":"APSP J Case Rep"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1016\/S0003-4975(01)03183-6","article-title":"Management of neonatal bronchovenous fistula after cardiopulmonary bypass","volume":"73","author":"O Reinhartz","year":"2002","journal-title":"Ann Thorac Surg"},{"issue":"02","key":"ref17","doi-asserted-by":"crossref","first-page":"431","DOI":"10.4103\/1793-5482.185072","article-title":"Venous air embolism during endoscopic third ventriculostomy","volume":"13","author":"R Bala","year":"2018","journal-title":"Asian J Neurosurg"},{"issue":"02","key":"ref18","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/pan.12086","article-title":"Atypical presentation of air embolism in an infant undergoing ventriculoperitoneal shunt surgery","volume":"23","author":"M P Pandia","year":"2013","journal-title":"Paediatr Anaesth"},{"issue":"08","key":"ref19","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1111\/pan.12180","article-title":"Venous air embolism from Tisseel use during endoscopic cranial vault remodeling for craniosynostosis repair: a case report","volume":"23","author":"G G Felema","year":"2013","journal-title":"Paediatr Anaesth"},{"issue":"11","key":"ref20","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1111\/j.1460-9592.2008.02617.x","article-title":"Documentation of resuscitation of an infant with pulseless electrical activity because of venous air embolism","volume":"18","author":"G Fuzaylov","year":"2008","journal-title":"Paediatr Anaesth"},{"issue":"03","key":"ref21","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1213\/ane.0b013e3181adc6f9","article-title":"Cardiac arrest in the neonate during laparoscopic surgery","volume":"109","author":"K Lalwani","year":"2009","journal-title":"Anesth Analg"},{"issue":"05","key":"ref22","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1213\/00000539-199305000-00037","article-title":"Probable venous air embolism during epidural placement in an infant","volume":"76","author":"N Schwartz","year":"1993","journal-title":"Anesth Analg"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"1271925","DOI":"10.3389\/fped.2023.1271925","article-title":"A 7-month-old girl with a suspected air embolism complication during a living-donor liver transplantation procedure: a case report","volume":"11","author":"D Huang","year":"2023","journal-title":"Front Pediatr"},{"issue":"06","key":"ref24","doi-asserted-by":"crossref","first-page":"rjy119","DOI":"10.1093\/jscr\/rjy119","article-title":"Extracorporeal cardiopulmonary resuscitation in a neonate after air embolism during insufflation for laparoscopic peritoneal dialysis catheter placement","volume":"2018","author":"L DiChiacchio","year":"2018","journal-title":"J Surg Case Rep"},{"issue":"04","key":"ref25","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s10140-007-0681-2","article-title":"Cerebral arterial air embolism in a child after intraosseous infusion","volume":"15","author":"R R van Rijn","year":"2008","journal-title":"Emerg Radiol"},{"issue":"04","key":"ref26","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1177\/0310057X9902700417","article-title":"Gas embolism produced by hydrogen peroxide abscess irrigation in an infant","volume":"27","author":"C Schwab","year":"1999","journal-title":"Anaesth Intensive Care"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.resuscitation.2015.06.007","article-title":"Prevalence of systemic air-embolism after prolonged cardiopulmonary resuscitation in newborns: a pilot study","volume":"93","author":"F JJ Halbertsma","year":"2015","journal-title":"Resuscitation"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1161\/01.RES.48.3.344","article-title":"Leukocytes are required for increased lung microvascular permeability after microembolization in sheep","volume":"48","author":"M R Flick","year":"1981","journal-title":"Circ Res"},{"issue":"03","key":"ref29","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1002\/(SICI)1099-0496(199903)27:3<147::AID-PPUL1>3.0.CO;2-P","article-title":"Altered endothelial function in lambs with pulmonary hypertension and acute lung injury","volume":"27","author":"J R Fineman","year":"1999","journal-title":"Pediatr Pulmonol"},{"issue":"09","key":"ref30","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1007\/s001340050993","article-title":"Inhaled nitric oxide improves hemodynamics during a venous air infusion (VAI) in dogs","volume":"25","author":"J E Tanus-Santos","year":"1999","journal-title":"Intensive Care Med"},{"issue":"05","key":"ref31","doi-asserted-by":"crossref","first-page":"1990","DOI":"10.1152\/jappl.1989.67.5.1990","article-title":"Furosemide reduces lung fluid filtration in lambs with lung microvascular injury from air emboli","volume":"67","author":"M E Berner","year":"1989","journal-title":"J Appl Physiol"},{"issue":"01","key":"ref32","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1161\/01.STR.21.1.94","article-title":"The effect of gas emboli on rabbit cerebral blood flow","volume":"21","author":"S C Helps","year":"1990","journal-title":"Stroke"},{"issue":"02","key":"ref33","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1097\/NAN.0b013e31819916da","article-title":"Reducing the risk of air embolism","volume":"32","author":"L A Gorski","year":"2009","journal-title":"J Infus Nurs"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2508-2733.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T22:37:51Z","timestamp":1759271871000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2508-2733"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,27]]},"references-count":32,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,9,30]]},"published-print":{"date-parts":[[2025,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2508-2733","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,12,27]]},"published":{"date-parts":[[2024,12,27]]}}}